Victor Wallace is a 74-year-old Caucasian male who was diagnosed with moderate Alzheimer disease 2 years ago. Mr. Wallace lives with his 50-year-old daughter, Anne Marie, who is his primary caretaker.

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Question 1: Mr. Wallace’s observations at the clinic correlate with the changes reported by his daughter. He showed signs of confusion and anxiety at both home and the adult daycare center. The language skills of Mr. Wallace have declined and he often uses inappropriate words when describing common items. He relies on scanning speech to find words, and he repeats the phrase “That’s how it is” when he cannot find the words he wants. Mr. Wallace’s agitation, sitting on the edge of his chair, tapping his foot, and rapping his hands on his knees, corresponds to the reported anxiety. Mr. Wallace’s refusal to perform ADLs and his belief that there is no point in trying because he won’t be able to do them much longer is also consistent with the changes Ms. Wallace reported.

Question 2: Mr. Wallace’s presentation prompts testing for depression because he scored high on the Cornell Scale for Depression in Dementia, indicating a high probability of depression. Depression can also be characterized by his decline in speech, confusion, agitation and apathy. The nurse can further evaluate whether Mr. Wallace’s behavior is due to his dementia or if depression is also a factor.

Question 3: Mr. Wallace’s increased confusion in familiar settings is a concern for Ms. Wallace because it indicates a decline in his cognitive abilities. His increased confusion could be a danger to him as he attends an adult daycare center every day. Ms. Wallace may worry about her father’s ability to remain independent and safely perform daily tasks.

Question 4: It is important to distinguish between Mr. Wallace’s refusal to perform ADLs and an inability to do so because refusal indicates a behavioral issue, while an inability is a functional issue. The reason why Mr. Wallace refuses to perform ADLs must be identified, so that an intervention to correct the problem can be implemented. Interventions can be used to slow or maintain the decline of his function if he cannot perform ADLs.

The speech therapy could help Mr. Wallace maintain or slow down his language ability. However, his decline in language may be due to his Alzheimer’s disease, and there may be limited benefits to speech therapy in these cases. Also, it may not be able to address any other symptoms like anxiety or depressive disorders.

Question 6: A change in Mr. Wallace’s Alzheimer’s medication from memantine to donepezil would not necessarily affect the doctor’s choice of SSRI for depression. Both memantine and donepezil are used to treat Alzheimer’s disease, but they have different mechanisms of action. Memantine acts as an NMDA antagonist and donepezil works as an acetylcholinesterase inhibitor. The choice of SSRI for depression would be based on the patient’s individual needs and response to treatment rather than the specific Alzheimer’s medication they are taking.